Nursing care of patient with CAD.

1. Mr.Veerabhadra.B.Badiger
Asst Professor
Dept of Medical Surgical Nsg.

3. Coronary artery disease
 The coronary arteries are the blood vessels that
supply the oxygenated blood to heart.
 Coronary artery disease is a condition characterized
by the narrowing or blockage of the coronary
arteries , usually caused by atherosclerosis.
 Atherosclerosis is the collection of cholesterol and
fatty deposits (called plaques) inside the arteries.

4.  These plaques
can deposit in
the arteries or
damage the
arteries, which
limits or stops
blood flow to the
heart muscle.

5. Atherosclerosis

6. Causes for CAD
 Smoking
 High blood pressure
 High cholesterol
 Diabetes or insulin resistance
 Sedentary lifestyle
 Atherosclerosis

7. Risk Factors
Modifiable risk factors
 Being overweight or obese
 Diabetes
 Unhealthy diet , including a lot of food that
has high saturated fat, trans fat, salt, and
sugar
 Smoking or secondhand smoker
 Lack of physical activity
 High blood pressure and high cholesterol
 High stress

8. Non-modifiable risk factors
 Age, especially being older than 65
 Race . African Americans have a higher risk than
people of other
 Gender. Men have a greater risk of heart
attack, However, the risk for women increases
after menopause
 Family history
Continued….

9. Other possible risk factors
 Sleep apnea. Sudden drops in blood oxygen levels
that occur during sleep apnea increase blood
pressure and strain the cardiovascular system,
possibly leading to coronary artery disease.
 High-sensitivity C-reactive protein (hs-
CRP). High hs-CRP levels may be a risk factor for
heart disease.
 High triglycerides. High levels may raise the risk of
coronary artery disease, especially for women.

10.  Homocysteine. Homocysteine is an amino acid
body uses to make protein and to build and maintain
tissue. But high levels of homocysteine may
increase risk of coronary artery disease.
 Preeclampsia. Occurs in women during pregnancy
causes high blood pressure and a higher amount of
protein in urine. It can lead to a higher risk of heart
disease later in life

11.  Autoimmune diseases. People who have
conditions such as rheumatoid arthritis and lupus
(and other inflammatory conditions) have an
increased risk of atherosclerosis.
 Alcohol use. Heavy alcohol use can lead to heart
muscle damage. It can also worsen other risk factors
of coronary artery disease.
 Contraceptive uses

12. Due to etiological factors
Injury to the endothelial cell that lining the artery
Inflammation and immune reactions
Accumulation of lipids in the intima of arterial wall
T lymphocytes and monocytes that becomes as
macrophages infiltrate the area to ingest the lipids and
die
Pathophysiology

13. Proliferation of smooth muscle cells with in the vessel
Formation of fibrous cap over dead fatty core
(atheroma)
Protrusion of atheroma in to the lumen of vessel
Narrowing and obstruction
If cap is thin the lipid core may grow causing it to
rupture

14. Hemorrhage into plaque allowing thrombus to develop
Thrombus and obstruct the blood flow leading to
sudden cardiac death of myocardial infarction
Angina and other symptoms

15. Clinical features
The most common symptom is angina, or chest pain
which is
 Aching , Burning , Fullness , Heaviness , Numbness ,
Pressure , Squeezing type.
(People mistake with indigestion or heartburn.)
 The pain may radiated to Arms ,Back ,Jaw ,Neck
.Shoulder
 Nausea / Vomiting.
 Faster heartbeat

16.  Palpitations
 Shortness of breath
 Sweating
 Weakness or dizziness
Angina pain

17. Diagnostic studies
 History collection.
 Physical examination
 ECG
 Cardiac enzyme test.
 2D-echocardiogram.
 Stress test/ tread meal test.
 Cardiac angiography.
 Coronary angiography.

19. ECG changes

20. Stress test
CT Angiography
2D-echo

21. Treatment
Treatment for coronary artery disease usually involves
lifestyle changes and, if necessary, drugs and certain
medical procedures.
Lifestyle changes
 Quit smoking.
 Eat healthy foods.
 Exercise regularly.
 Lose excess weight.
 Reduce stress.

22. Management
 Anti anginal medications : Nitroglycerin tablets,
sprays and patches can control chest pain.
 Beta adrenergic blockers : Slow the heart rate
and decrease blood pressure ex- Atenolol
 Calcium channel blockers :- Nefidipine

23.  Ace inhibitors / Angiotensin-converting enzyme
(ACE) inhibitors : Drugs decrease blood pressure
and may help prevent progression of coronary artery
disease (captopril)
 Statins / Cholesterol-lowering medications:
Atorvastatin, Rosuvastatin, Fluvastatin
 Oxygen administartion.
 Nitroglycerin.
 Morphine :

24.  Surgical management
Surgical procedures to help restore blood
flow to the heart
 Percutaneous transluminal coronary
angioplasty (PTCA)
 Coronary artery bypass grafting (CABG)

25.  Percutaneous transluminal coronary
angioplasty (PTCA)
 PTCA is accomplished using a balloon-tipped
catheter inserted through an artery in the groin or
wrist to enlarge a narrowing in a coronary artery

26.  Coronary artery bypass grafting (CABG)
 CABG is the most common type of open-heart
surgery , a healthy artery or vein from the body is
connected, or grafted, to the blocked coronary
artery.

27. Nursing diagnosis
 Acute Pain
 Deficient Knowledge
 Anxiety
 Risk for Decreased Cardiac Output

28.  end